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CMS to Cover HCV Screening for High-Risk Adults
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The Centers for Medicare and Medicaid Services announced in June that it will cover a screening test for adults at high risk for hepatitis C virus.
High risk is defined as those individuals with a current or past history of injection drug use and those who received a blood transfusion before 1992. Repeat screening for high-risk individuals is covered annually only for those with continued injection drug use since the prior negative screening test, according to the decision memo.
CMS will also cover a single screening test for adults who do not meet the classification of high risk, but were born from 1945 through 1965.
The evidence is adequate to conclude that screening for HCV, consistent with the grade B recommendations by the US Preventive Services Task Force, is reasonable and necessary for the prevention or early detection of an illness or disability and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B, as described [above], according to the memo.
CMS will cover screening for HCV with the appropriate FDA-approved and/or cleared laboratory tests, used consistent with FDA-approved labeling and in compliance with the Clinical Laboratory Improvement Act (CLIA) recommendations, when ordered by the beneficiarys primary care physician or practitioner within the context of a primary care setting, and performed by an eligible Medicare provider for these services, according to the memo.